To think the junior / resident doctors are greedy, selfish, entitled & lazy?

[SpottyAlpaca]

So the resident doctors are out on strike. Yet again. Patients are being inconvenienced & treatments delayed. Yet again.

They have received a pay rise of 28.9% over that last 3 years, which is by far the highest increase of any group in the public sector. Very few people in the private sector, who ultimately pay the doctors’ salaries, have received anything like as much. Very few of their patients will ever earn as much as a resident doctor. Yet still it’s not enough and they are demanding even more.

Doctors do an important job and deserve to be paid properly for it. But the BMA’s current approach is completely unreasonable and deluded. They talk about “pay restoration’ to 2008 levels but that’s completely unrealistic. The country is poorer now & simply can’t afford it. AIBU to think they should get back to work?

Apologies and thanks for putting me right.

I was responding to a question about what a resident doctor was and was trying to explain that they are doctors in training.

As you say, staff grades and associate specialists must be among the forgotten workers in the NHS as I couldn't find any current reference to them and assumed that apart from those still employed in the NHS they were being gradually phased out.

But I suppose if a resident/junior doctor isn't going on for whatever reason to become a consultant then there needs to be another career home for them

I've no doubt it can be very difficult at times but many if not most jobs have their own particular difficulties and hardships.

But having worked in the NHS for 25 years I don't accept the picture I think many strike supporters paint which implies that resident doctors are having to put up with these deprivations and to make these sacrifices 24/7 in every specialty.

I had a regular follow up OP appointment at my local hospital yesterday afternoon and the resident doctors I saw later were enjoying lunch in the canteen. And while I was in the waiting room they were having no difficulty accessing the staff toilets. And they were sat down a lot too.

I also think the BMA leadership and strike supporters are being disingenuous when they only quote basic salary figures for Foundation 1 and Foundation 2 doctors without explaining any context.

If a staff grade or assoc spec is not going to end up with the salary and career prospects of a consultant then they really are the cinderellas of the NHS medical staff and I sympathise with them.

Who would want their children to take a full loan if they could afford to top up the minimum loan? It’s not a grant. That’s just weird.

Parents who are struggling to pay bills on their NHS salery and support a disabled husband. That's who, an exta 2 to 3 K on top of a minimun 4.5k might just cover the accomodation. Besides we keep being told to consuder it a gradute tax .

yep, any profession or job starts on a low salary and works themselves up. Doctors are no different.
As for nurses bleating on about low pay, I initially thought they must be on about 21K a year or something. Nope there are decent salaries to be made in nursing if people can be bothered to do the qualifications and rise up the ranks

@jamimmi Your dc get the lien based on your income. Most students get the minimum loan and parents top up. They don’t get the option of the full maintenance loan and that would apply to nurses on an average salary for nurses. You could try working for a different employer and give up your amazing pensions. If you really think the private sector is paying better, go and get it!

1. We pay taxes, unlike some "private " sector workers we cant fiddle these on self assessment, pay ourselves dividends and get out kids full student loans as one fruend has told me they did. I belive the words were creative accounting ( a very sore point in this house)

Tax is deducted on your pay slip, correct. It does not add to the amount of money that the government has available to spend, because it was paid to you out of taxation.

1. We.contribute to our pensions, and they are no longer final salery schemes

Correct. But they are defined benefit and still gold plated compared to the defined contribution paid into by most of the private sector. That's without even putting a monetary figure on the inflation proofing, surviving partner benefit and peace of mind from the certainty about how much you will receive.

1. Having worked over 30 years in the NHS i can assure you all the vast majority of staff dont get breaks, normally work in excess of their hours and miss alot of family events due to shifts. Not a issue.we know what we signed up for but the we need to privatise to increase efficany is laugable, we need adequate resources to improve efficany.

I don't doubt you are right about most of the staff working on wards and in A&E, for example. But I've unwillingly been in too many hospitals too many times in the last few years and by no means does it describe the jobs of everyone.

On Wednesday last week I watched for 4 hours while waiting for an eye operation as a day case. Two nurses booked in 3 people and put drops in their eyes. For 45 minutes they sat and chatted. Then they gave the first returning patient their discharge notes and medication and a cup of tea. That was repeated for another patient, then me. As I sat with my cup of tea they greeted 4 more patients and will likely have spent the second half of their shift chatting for the overwhelming majority of their time. This has not changed in the 11 years since I had an operation on a tooth in the same unit, it was the same then.

The anaesthetist did one local anaesthetic per hour and stood around waiting for the next patient. When I had cataract surgery in a private hospital the surgeon did the anaesthetic. In the NHS, with the same surgeon, their was an anaesthetist with similarly relaxed workload .

The nurses who do my routine eye tests in my local hospital have a very relaxed schedule, doing exactly the same job using the same machines as the technician in my optician used to.

I could give you numerous examples of situations like that, that you just don't see happen in the private hospitals. I love the NHS and the many people who work so hard in it but I'm fed up with the myth that every NHS worker is some kind of saint working themself to a frazzle, who deserves 10% off in the shops that are staffed by people working harder and for less pay than many of them are.⁹

The anaesthetist did one local anaesthetic per hour and stood around waiting for the next patient. When I had cataract surgery in a private hospital the surgeon did the anaesthetic. In the NHS, with the same surgeon, their was an anaesthetist with similarly relaxed workload

tell us you're not an ophthalmic surgeon/anaesthetist without telling us you're not an ophthalmic surgeon/anaesthetist! There are usually medical reasons for the set-ups you've described. Despite the fact it often does look pretty chill, day case eye surgery is definitely not as relaxing as you might imagine. There definitely are inefficiencies in the NHS, but I think you've probably picked a bad example here.

I have given you an example of the exact same operation done by the exact same surgeon under private and NHS conditions. What more do you want?

When I saw my eye consultant the hospital said I was only the third person to turn up. No reminders sent so he twiddled his thumbs all day. The NHs is not fit for purpose. Wastes resources and needs to understand what modern business looks like and what efficacy and productivity looks like.

The variation from one unit to the next drives me nuts. It's as if they can't say "this is what works in another department/another hospital/another NHS Trust, do it here! Even for things where there appears to be no clinical reason not to.

Between me and my husband we are under the care of two NHS districts, four NHS hospitals (was 6 in the last 2 years) 6 different ologies with 7 different consultants, and several different appointment booking systems, some of which demand confirmation and send multiple phased reminders and some of which don't. Some of which are wasting serious amounts of money to send paper letters of appointments and appointment notes when others in the same hospital are using apps and free email.

I love the whole principle and ethos of the NHS. I hate it failing to deliver those when some of the solutions are simple and already in practice in other parts of it.

Agreed. Once upon a time, GPs referred directly to consultants. Consultants prioritised referrals and their secretaries fitted them in and sent out appointments. If a patient was, or became, unable to attend they had a direct line telephone number to the secretary who had sent out the appointment; who would then fill the slot with another patient. DNAs - wasted appointments - occurred but they were rare. There was the added benefit that GP/consultant dialogue often resulted in an alternative approach, including direct admission.

Central bookings put an end to that, and long waiting times compounded problems, as patients circumstances changed, including death. Between 1 in 4 and 1 in 5 appointments are wasted now - and it is entirely fixable.

https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2024-25/summary-reports

I can imagine the referral problems getting worse. I forget the exact details, but GP’s are going to start referring for “advice and guidance” regarding a patient, rather than an actual consultant appointment. Which sounds like another way to get waiting lists down fraudulently whilst pinning the blame on the hapless GP, who frankly might as well be replaced by Alexa at this point.

A referral should be able to be made with a few mouse clicks. The system should automatically find the soonest available appt. The NHS is still living in the 70s with talk of letters and secretaries etc.

I work for a private business and we have a budget a fraction of that of the NHS and that's how we do it. Why is the NHS so resistant to modernisation?

In a private company, the initial workaround to that situation, if you are running a big enough operation, is to over schedule by the 20-25% of people who you know won't turn up, prepared to extend times and pay overtime for the rare days when they do.

In practice, one of our ologies is doing that, but the only way they can force the system to double book is to give out appointment times that are before the clinic is even open and then ring the person and tell them not turn up until later. I kid you not, we have exactly that going on on Monday morning for an NHS cardiologist-monitored MRI.

Parts of the NHS are trying really hard. In recent months we've had routine gastroscopy on a Sunday and have routine ultrasound scanning tomorrow also on a Sunday. They are doing their best with seriously creaky administrative systems.

They are not only being paid to do this but have now been given a target that they must do this for 1 in 4 referrals!

I was answering the person who was saying their friend used creative accounting to pretend they were earning less than they were so their kids could get the full loan.
Obviously if you are lower income then your kids should have the full loan.
but actively lying to choose it, when you could afford to top it up as a parent, is weird.

I could have done that… but it wasn’t even a consideration

The booking system needs to be a lot more complicated than that unfortunately, and tuned per department to clinical need that can only be decided by a consultant. That's the function the consultant's PA used to carry out so effectively.

A person who can't walk up the stairs to get to bed should leap frog someone who's having trouble walking 4 miles due to breathlessness from an inefficient heart, but not for so long that the person who can't walk 4 miles turns into a person who can't walk upstairs.

This is changing. In Scotland you can opt into paperless communication via text. No more missed letters.

It shouldn't be opt in. It should just be the way it is.

What about elderly people who may not have access to smartphones and computers?

You already can't book a GP appointment without online triage at many practices. At mine the receptionist fills it in while on the phone to the patient if the patient hasn't got access. It works and there are fewer people needing this every year, even the elderly mostly like smart phones! Most U3A groups, clubs for the retired with a big age skew on membership, are managed by apps.

@ImdunferMy U3A doesn’t have an app. It just has a web page.

with insight that none of this particularly useful in a thread about RD strikes...

you may have been having the exact same operation done by the exact same surgeon under private and NHS conditions..... it would be unusual to have a whole list of entirely similar patients though, and even more unusual for an individual patient to have a full grasp of everything else's surgery/medical problems when they're only in theatre for their own case.

There are minimum standards in ophthalmology surgery/anaesthesia which IIRC do advise that there should be an anaesthetist available within the theatre suite whenever needle blocks are being performed even if it's the surgeon doing the block (I've certainly been that anaesthetist in the past). There's a little more 'freedom' in the private sector (and quite often the higher risk customers will have been batted back to the NHS so they're looking after a bunch of more physiologically robust customers there). Where there isn't an anaesthetist available the surgeon is responsible for managing resuscitation in the event of one of the rare-but-not-unheard-of, unpredictable, life-threatening complications of needle blocks. It might not look terribly efficient when everything's going well, but if you were the unlucky patient, you might be grateful that there was a relaxed looking anaesthetist hanging about nearby.

Purely topical anaesthesia is slightly different and low risk in terms of the anaesthetic and there isn't usually anaesthetic allocation to those lists, but given that a large chunk of the eye-surgery population is in pretty poor health it is often prudent to have someone with intermediate life support skills around because just occasionally they throw you a massive curve ball. Not everyone's suitable for topical anaesthetic, but if they are then the surgeon's will bosh through a whole bunch of them fairly quickly. Usually the aim is to cohort patients on lists so that there's all topicals/ all blocks without sedation/all complex patients to max out on efficiency but that isn't always so practical and sometimes things have to change on the day.

Lots of surgeons are very happy to do their own blocks and that does cut some costs when it goes well (particularly important in the private sector because you don't have to pay for the anaesthetist). If the surgeon's doing the blocks though they can't be operating at the same time and productivity may be lower.... means you'll all be waiting even longer for your operations. If there's an anaesthetist doing the blocks, they can be starting the next case while the first is still being finished off.

it would be unusual to have a whole list of entirely similar patients though,

Wrong again, I heard what he said to each of us. 6 bog standard lens replacements under local anaesthetic in people of a similar age.

. If there's an anaesthetist doing the blocks, they can be starting the next case while the first is still being finished off.

This wasn't the case, we were taken and returned one at a time, both for the cataracts only session and for the recent cataract/glaucoma session.

This is what I meant earlier about how frustration it is to see parts of the NHS work well and the identical procedures/adminisration/whatever is more resources or be done badly.

In private industry if two sections doing the same type of work had different productivity outcomes, the worse one would be JFDI'd.